Re-thinking vaccines - a report

Re-thinking vaccines

This session organized by the European Research Council aimed to question the way we think about vaccines – not only as solutions to specific diseases, but as potential tools against antibiotic resistance, COVID-19, and disease more generally.

Dr. Jason Reifler, Professor of Political Science at the University of Exeter, opened the session by addressing the issue of distrust of vaccines, and of how misinformation about vaccines is spread. While the public widely recognizes the value of vaccines, he said, many people (around 40%) also have strong concerns about the side effects of vaccines that have allowed for misinformation and distrust to proliferate.

Reifler’s research has shown that providing people with information countering misperceptions about the risks of vaccines is more effective than trying to ‘scare’ people into getting vaccines by warning them about the dangers of a disease—except for those already the least likely to get vaccinated, among whom it had the opposite effect.

When it comes to COVID-19, the large majority of people would be likely to get a COVID-19 vaccine at some point according to Reifler’s research, regardless of their views on pharmaceutical companies.

“What people are really going to care about and what’s really going to affect the uptake of a COVID-19 vaccine,” he said, “is how public health messaging and key political figures are able to prevent bad actors from getting into the public conversation, particularly with claims around exaggerated side effects.”

Reifler warned against the dangers of rushing a COVID vaccine that has not been adequately tested. “While there is incredible immediate need for a vaccine, the long-term consequences of getting it wrong, for COVID specifically and for vaccines generally, are very severe. As a society, we’re prepared to accept documented risks but we’re not prepared to accept undocumented risks.”

Reifler was followed by Dr. Rino Rappuoli, Chief Scientist and Head of External R&D at GSK Vaccines in Siena, Italy and Professor of Vaccines Research, Imperial College, London. Rappuoli emphasized the enormous contribution made by vaccines to improving human life expectancy over the last centuries ––by 35 years since 1900 alone.

Infectious diseases take away our freedom, he said. But together with hygiene and antibiotics, vaccines can restore it. And vaccines have advantages that hygiene and antibiotics don’t: hygiene, while extremely effective, can take 40-50 years and is very costly to implement in a developing country; while antibiotics are also a powerful tool, but become obsolete quickly due to acquired resistance and need to be frequently replaced. Vaccines, in contrast, are able to control diseases quickly and for a very long time, without generating resistance. “When vaccines conquer a disease, they conquer it forever,” said Rappuoli.

Vaccines can also offer a potential solution to two pressing problems: antibiotic resistance, and COVID-19. Vaccines can be developed against diseases normally cured by antibiotics, by generating antigens from antibodies present in those who have had the disease. With respect to COVID-19, there are hundreds of vaccine candidates being developed at an unprecedented pace, in part thanks to new technologies based on synthetic genes, and delivered by viral vectors. “Today to make vaccines you don’t need the virus anymore,” said Rappuoli. You only need the sequence of the virus downloaded from the internet.”

Rappuoli said that the use of monoclonal antibodies as a preventive treatment will likely be ready even earlier than a vaccine, as they can be rapidly industrially generated–but there are some concerns about their effectiveness. He underlined the need to pay careful attention to the safety and efficacy of both monoclonal antibodies and synthetic gene-based vaccines, which have not been deployed before on a wide scale. Still, he ended optimistic that fast and safe vaccines and monoclonal antibodies can be produced against COVID-19.

The last panelist in the session, Dr. Christine Benn, Professor in Global Health at the University of Southern Denmark, studies vaccines from an epidemiological point of view. Specifically, she looks at the non-specific effects of vaccines, or the ways in which vaccines “train” the immune system in ways that no one expected.

Vaccines have always been evaluated and monitored according to their ability to improve immunity to a particular disease, she said. But the effects on overall health have never been evaluated. When Dr. Benn researched this question in Africa, she found a surprising effect: when live vaccines were administered to children, overall mortality was reduced much more than anticipated or explained by the prevention of the disease vaccinated against. However, when children received non-live vaccines, overall mortality was increased in girls (though not in boys).

Dr. Benn said that live vaccines are acting like a stimulant for the entire immune system. “I like to think of live vaccines as a tennis court, with a really good opponent who makes you run around the court and prepares you to compete,” she explained. “Non-live vaccines are like a ball machine, which teaches you to react very well to one very specific target.”

This stimulant property is being tested now against COVID-19, as the BCG vaccine against tuberculosis has been shown to offer some potential immunity against the SARS-COV-2 virus.

Dr. Benn argues for a paradigm change in the way we think about vaccines, arguing that they not only treat specific diseases but act as more general “training” for the immune system. “The immune system is wonderfully complex. It’s like a brain, it learns from experience and it can translate that experience into other unrelated situations.”

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